Dentist - Towson
8600 LaSalle Rd. Suite 406 Severn Bldg.
Towson, MD 21286
410-321-0551

Posts for: August, 2018

TheresStillHopeforaRe-InfectedToothAfterRootCanalTreatment

Most first-time root canal treatments achieve their purpose in saving an internally decayed tooth and extending its life to match those of the patient’s non-decayed teeth. Occasionally, though, a root canal-treated tooth may become re-infected by decay.

There are a number of reasons for this: the permanent crown meant to add further protection against decay may have been delayed, giving bacteria an opening to re-infect the tooth; it’s also possible the original seal for the pulp chamber and root canals after filling wasn’t sufficient to prevent bacterial contamination.

There‘s also another reason that’s very difficult to foresee — the presence of narrow, curved root canals in the tooth that can pose complications during the procedure. Some of these known as accessory or lateral canals branch off the main canals to create a complex network that’s difficult to detect during the initial procedure. If they’re not cleaned out and filled during the procedure any tissue trapped in them can remain infected and ultimately die. If these canals also open into the periodontal membrane at the attachment between the teeth and bone, the infection can spread there and become a periodontal (gum) infection that can trigger future tooth loss.

Fortunately, a reoccurrence of infection isn’t necessarily a death sentence for a tooth. A second root canal treatment can correct any problems encountered after the first treatment, especially complications from accessory canals. It may, though, require the advanced skills of an endodontist, a dental specialist in root canal problems. Endodontists use microscopic equipment to detect these smaller accessory canals, and then employ specialized techniques to fill and seal them.

If you encounter pain or other signs of re-infection for a tooth previously treated with a root canal procedure, contact us as soon as possible. The sooner we can examine and diagnose the problem, the better your tooth’s chances of survival by undergoing a second root canal treatment.

If you would like more information on tooth preservation through root canal treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Accessory Canals.”


By Dr. Mark Shulman
August 25, 2018
Category: Oral Health
BeontheAlertforGumDiseaseWhileWearingBraces

On your way to a more attractive smile, you’ll have to deal with some inconveniences while wearing braces like avoiding certain foods or habits or dealing with possible embarrassment about your new “metal smile.” But there’s one consequence of wearing braces that could dramatically affect your dental health: the difficulty they pose for keeping your teeth clean of dental plaque.

Dental plaque is a thin film of bacteria and food particles that if allowed to build up on tooth surfaces could trigger tooth decay or periodontal (gum) disease. Brushing and flossing thoroughly every day helps prevent this buildup.

Unfortunately, metal brackets and wires can get in the way and cause you to miss areas while performing these hygiene tasks. This could cause plaque buildup in those isolated areas that could trigger an infection. And if you (or someone you love) are also a teenager, the natural adolescent surge in hormones can increase your infection risk.

If while wearing braces you notice your gums are reddened, swollen or bleeding when you brush, these are all signs of infection and the body’s inflammatory response to it. The longer the infection continues, the weaker the tissues become, causing them to gradually detach from the teeth. Along with bone deterioration (another effect of the disease), this can ultimately lead to tooth loss.

To prevent this from happening, you’ll need to be as thorough as possible with daily brushing and flossing. To help make it easier, you can use special tools like an interproximal brush that can maneuver around the braces better than a regular brush. For flossing you can use a floss threader to more readily guide floss between teeth or a water flosser that uses a pressurized stream of water rather than floss thread to remove plaque.

This extra cleaning effort while wearing braces can greatly reduce your disease risk. But you’ll still need to keep an eye out for any symptoms like swollen or bleeding gums, and see your dentist as soon as possible. If the symptoms become severe you may need your braces removed until the disease can be brought under control. The health and future vitality of your teeth and gums is what’s of primary importance.

If you would like more information on dental care while wearing braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gum Swelling During Orthodontics.”


DentalCareofPrimeImportanceforChildrenwithSpecialHealthNeeds

Children’s ailments come and go, and thankfully most are relatively minor. Some children, however, have impaired health caused by a more serious, chronic disease. For them, the condition impacts not only their overall well-being, but also their dental health.

This often occurs because the specific healthcare needs of children with these chronic conditions are given greater priority over dental health. Besides the treatment focus, children with special healthcare needs may have physical, mental or behavioral limitations that can make it difficult to keep up with oral hygiene and care.

Children with autism or attention deficit and hyperactivity disorder (ADHD) may have a difficult time practicing (or cooperating with) oral hygiene tasks. Some may not have the physical ability to perform effective brushing and flossing without assistance. In these cases, it’s important for parents or caregivers to seek out instruction and training that will optimize their children’s hygiene and so reduce the chance of dental disease.

Certain medications for chronic conditions can increase mouth dryness, or they’re acidic or sweetened with sugar, any of which can increase the child’s risk for tooth decay or periodontal (gum) disease. Parents or caregivers should consult with their physicians about these medications or if they could be administered at mealtime to minimize their effect on the mouth.

Finally, there’s the direct effect some conditions may have on a child’s teeth and gums. Children with severe gag reflexes due to their condition may not be able to tolerate toothpaste or be able to spit it out completely. Other conditions can give rise to dental defects such as enamel hypoplasia in which not enough enamel develops to adequately protect the teeth.  Such defects call for special dental attention and closer monitoring of teeth and gum health.

The key is to see us and the other healthcare providers for your child’s chronic condition as part of an overall team. Sharing information and regarding both dental and general care as part of a comprehensive strategy will help to prevent dental problems from developing and improve their health.

If you would like more information on dental care for children with chronic conditions, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Managing Tooth Decay in Children with Chronic Diseases.”


WhatHappensinaRootCanalTreatmentandHowitCanSaveYourTooth

Along with periodontal (gum) disease, tooth decay poses one of the two greatest threats to your teeth. Cavities are just the start: if decay invades the pulp, the tooth’s innermost layer, the infection created can continue to advance through the root canals to the supporting bone. This worst case scenario could cost you your tooth.

But we can stop this advanced decay in its tracks with a procedure called a root canal treatment. A root canal essentially removes all the infected tissue within the tooth and then seals it from further infection. And contrary to its undeserved reputation for being painful, a root canal can actually stop the severe tooth pain that decay can cause.

At the beginning of the procedure, we deaden the affected tooth and surrounding tissues with local anesthesia—you’ll be awake and alert, but without pain. We then isolate the tooth with a dental dam of thin rubber or vinyl to create a sterile environment around it to minimize contamination from bacteria found in saliva and the rest of the mouth.

We then drill a small hole through the enamel and dentin to access the interior of the tooth. With special instruments, we remove and clean out all the diseased or dead tissue in the pulp chamber and root canals. After disinfecting the empty spaces with an antibacterial solution, we’ll shape the root canals to make it easier to perform the next step of placing the filling.

To fill all the root canals and pulp chamber, we typically use a rubber-like material called gutta-percha. Because it’s thermoplastic (“thermo”—heat; “plastic”—to shape), we can compress it into and against the walls of the root canals in a heated state to fully seal them. This is crucial for preventing the empty tooth interior from becoming re-infected. Afterward, we’ll seal the access hole with its own filling; later, we’ll bond a permanent crown to the tooth for additional protection and cosmetic enhancement.

After the procedure you may have some temporary minor discomfort usually manageable with aspirin or ibuprofen, but your nagging toothache will be gone. More importantly, your tooth will have a second chance—and your dental health and smile will be the better for it.

If you would like more information on treating tooth decay, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Step-By-Step Guide to Root Canal Treatment.”


By Dr. Mark Shulman
August 10, 2018
Category: Dental Procedures
Tags: teeth whitening  
3ReasonsYouShouldConsiderToothWhitening

White, translucent teeth are the hallmark of a beautiful smile. But with age or the foods we eat our teeth’s natural brightness can dim to a dingy yellow.

If this is your case, you may be able to benefit from teeth whitening techniques that brighten up your less than “pearly whites.” A teeth whitening treatment from time to time could put the dazzle back in both your smile and your self-confidence.

Here, then, are 3 reasons for considering tooth whitening to improve your smile.

You might be able to do it yourself. There are a number of home whitening options (including whitening strips) that are safe and effective to use at home. But there are a couple caveats: because your dentist can use stronger bleaching solutions they may be able to perform the procedure in less time and with longer lasting results than a home kit. Also, some forms of staining originate inside a tooth—a home kit won’t help with that kind of discoloration.

It’s safe and relatively inexpensive. Home bleaching solutions aren’t strong enough to be harmful (unless you disregard the product directions) and are usually not very costly. Your dentist uses stronger solutions but with the training and curing equipment to minimize any risk to your teeth. And compared to other cosmetic treatments, dental office teeth whitening is still a relatively inexpensive option.

Dental office whitening can be more comprehensive and precise. Another reason to opt for your dentist to whiten your teeth is the wide range of discoloration they can alleviate. They have clinical techniques for alleviating internal tooth staining, and could even combine these with treatments for external staining. Your dentist can also help you achieve the exact degree of whiteness you desire—from a more subtle, natural shade to “Hollywood Bright.”

Whitening isn’t permanent—but with a thorough application and avoiding foods and habits that contribute to staining, professional whitening effects can last up to two years. If you’re interested, see your dentist for a full dental examination for any issues that might interfere with the whitening process. From there, you’re not far from a brighter and more attractive smile.

If you would like more information on teeth whitening and other dental cosmetic enhancements, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter….




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